Shriveled raisins: The bitter harvest of “affirmative” care

Posted on January 26, 2017 by 4thwavenow

Note to readers: This is another in an ongoing series of posts which shine a light on the public statements made by gender specialists in various forums. The aim here, as always, is to inform the public, particularly parents, about the actions and self-reported thoughts and plans of individuals who are currently involved in providing hormones and surgeries to minors. All screen captures are from publicly accessible (i.e. not password-protected or otherwise private) websites. We intend to continue to exercise our free-speech right to report on these public statements, as well as publishing our personal opinions on pediatric transition and those who enable and promote it.

To anyone who may object to our work in this area, hear this: The backlash represented by 4thWaveNow, Transgender Trend, Youth Gender Professionals, and the increasing number of individuals and organizations who question the burgeoning increase in child and youth transition is precisely that: a backlash against the decision taken by trans activists and their media handmaidens to relentlessly promote pediatric transition—especially MEDICAL transition.

The final straw, for many of us, has been the shameless and daily attempts by activists, journalists, and some clinicians to misuse self-harm statistics as a weapon to bludgeon parents into submission. A recent article in Spiked Online exposed this immoral and deeply destructive tactic, and we will continue to expose it on 4thWaveNow.

Scattered through the posts on this site, we have discussed the fact that puberty blockers followed by (or used concurrently with) cross-sex hormones to prevent the “wrong puberty” in prepubertal kids results in irreversible sterilization. This is well-recognized fact, openly acknowledged by researchers and top pediatric gender specialists alike [see the bottom of this post for a collection of links on this matter].

The reason is that gametes (sperm and ova) require natural, biological puberty to mature to the point that they are viable for reproduction. It is not currently possible to freeze immature gametes, as it is for those of adult trans people who have been allowed to go through natal puberty.

Our point is not that anyone and everyone should have biological children or that women are only fit to be baby machines (a red herring “argument” that has been used against us by trans activists). It also has nothing to do with the demographics of who will ultimately decide to bear or father children. (I notice none of these activists cavalierly argue for sterilization of disabled or gay people, both of whom have a lower statistical rate of becoming biological parents). The point is that it is a human rights violation to sterilize minors, who by definition cannot consent nor understand what it means to give up that future right. And given that the majority of “persisting” trans kids are same-sex attracted, it is not a stretch to see that prepubescent sterilization of “trans kids” amounts in many cases to a form of proactive anti-gay eugenics—even if that is not the conscious intention. What’s more, as many parents know, the decision to reproduce may come later in life, even if we thought in our youth that we wouldn’t have wanted children. Most young people naturally don’t spend their time thinking about having kids of their own; they have other priorities at that stage of life, as well they should.

But does any of this matter if adult trans people aren’t particularly interested in reproduction?

Well, it turns out that several studies have shown that a majority of trans men and trans women desire to have biological children of their own.

But even setting aside research evidence, all you have to do is look at the increasing number of (sometimes sensationalized) media stories about “pregnant men” to know this is “a thing”.

There are a sufficient number of trans men becoming pregnant and giving birth that the premier midwifery organization in the United States has changed all its literature to be “gender neutral” in an ostensible effort to avoid “triggering” its clients with words like “woman” and “breasts.” Planned Parenthood now campaigns on behalf of “menstruators” and the venerable La Leche League has even scrubbed its language of inconvenient mentions of biological reality, to ensure that trans men who want to “chest feed” won’t feel excluded.

But when it comes to the fertility of trans people, trans activists want to have their cake and eat it too: Celebrate and support adult trans who decide (often unexpectedly) to reproduce, while fiercely lobbying for medical intervention which permanently sterilizes prepubescent children. There is really no way to square this contradiction. They constantly claim that stopping the “wrong puberty” is the only antidote to suicide, yet that “wrong” puberty is the one and only pathway to possible reproduction in the future.

Not to put too fine a point on it, but the very people arguing that the only alternative to these sterilizing pediatric treatments is suicide are very much alive, and quite a fair few of them (notably, several top MTF trans activists) have biological children of their own. “Do as I say, not as I do” is rightly ridiculed as hypocrisy when it comes to any other subject. How on earth did these people survive to adulthood, father children, yet now harangue us that the “wrong” puberty of these children must be stopped?

As to the weaponization of suicidality: There is no record in the history of medicine of children and teenagers killing themselves because they could not medically transition in childhood, or because they were “born in the wrong body.” (Since August when this piece was posted, we’ve been waiting for any evidence to the contrary.) Even the most frequently cited “41%” study of trans adults who have reported suicidal ideation doesn’t assert that medical transition cures suicidality.

Source: Williams Institute, 2014

So, given that

large numbers of adult trans men and women express a desire to have biological children;
no child or pre-adolescent can know for certain whether or not they will eventually want to reproduce;
it is a universally acknowledged human rights violation to sterilize minors;
and there is no evidence that early medical transition will ultimately reduce self harming behaviors,

we must ask: Why do gender specialists continue the reckless practice of promoting sterilizing hormones and surgical interventions on prepubescent children, who, by virtue of their undeveloped powers of reason and judgment, cannot meaningfully consent to such treatments? On what authority does any adult—including these children’s parents—have the right to make a decision for a minor that should solely belong to adults of reproductive age themselves?

Even if it turns out to be true that most of these kids won’t opt for biological reproduction in the future, what of the (already limited) pool of potential life partners they might fall in love with? It’s not at all uncommon for couples to part company over disagreements about whether to have children. And then there’s the issue of what genital surgeries do to sexual response and function. None of this is ever discussed in the glowing portraits of “trans kids” that we see daily in the mainstream media (though it is by the clinicians themselves—as you’ll see shortly).

The gender specialists are fully aware of the irreversible effects of their interventions. Gender clinics detail the risks of infertility and other permanent changes on their consent forms. Research articles, public statements, and news articles capture the admissions by prominent gender specialists (again, see the bottom of this piece for links). Some express reservations (but no accompanying intention to cease and desist or even slow down their caseloads); some mention it in passing. And some, as you’ll see in a moment, appear to lose no sleep at night over what they’re doing, but only express interest in the future market for even more high tech interventions for the young people entrusted to their care.

Last March, Johanna Olson-Kennedy, MD (herself a parent), one of the world’s most successful and best known pediatric gender specialists, posted a call on the publicly accessible WPATH Facebook page for earlier genital surgeries on minors. We wrote about it at the time in this post.

The irony is inescapable: By puberty blocking young people, endocrinologists create a situation where these youth naturally yearn for puberty, as they watch their unblocked peers mature and move on. Olson-Kennedy’s solution? More high-tech, expensive medical intervention; earlier cross-sex hormones, earlier sex reassignment surgery. An iatrogenic problem created in the first place by suppressing the perfectly healthy bodies of young people.

Just a few days ago, Olson’s original post was revived via several new comments supporting her radical idea. This one, by Susan Maasch, founder of the Trans Youth Equality Foundation (TYEF) is particularly striking. ( We wrote about TYEF—a purveyor of free breast binders (secretly to girls with “unsupportive” parents) and youth transition propaganda, last year.)

“Shriveled raisins”: The outcome of years of hormone treatment unnatural to the female body.

Other activists and pediatric gender specialists, including Rixt Luikenaar (ironically, an OB-GYN), Kathie Moelig (founder of TransFamily Support Services), and others acknowledge that sterilization (which their clients may someday regret) will result from early surgeries and hormones, but place their faith in high-tech medicine to find a way around it—eventually.

This unquestioning belief that medical technology will solve the problems created by zealous “affirmative” gender specialists is widely shared. Just a couple of days ago, NPR ran an article acknowledging that immature gametes can’t currently be preserved for future reproduction. But by drawing on fertility preservation research in cancer survivors treated with sterilizing chemotherapy, the pediatric-transition pushers hope that puberty-blocked children’s ova and sperm can eventually be coaxed to reproductive viability in a petri dish.

Both groups — young cancer patients and trans kids hoping to transition early — have a demand for fertility preservation at an age where it has not usually been possible. But researchers say they are drawing closer to a solution with new techniques to freeze, or cryopreserve, immature reproductive cells…

… they started to look for ways to grow that tissue in a petri dish, so it can develop into a mature egg. “We’ve had to borrow knowledge from other disciplines and sort of figure out how that applies to trans people … What can be frustrating sometimes is having to adapt and extrapolate all of this information from work that is not done for trans people.” — Zil Goldstein, Mount Sinai

Brave New World. Puts a whole new spin on “test tube babies.” Not to mention a future boost for the surrogacy industry.

No one in the mainstream media—in this case, NPR– seems willing to point out the obvious: If you let these kids simply mature naturally–as their healthy bodies are desperately fighting to be allowed to do–they can preserve their fertility and decide whether they want to choose hormonal or surgical interventions when they reach adulthood, with mature judgment and reasoning powers. There would be the added benefit of giving kids a chance to desist before it’s too late—as so many were allowed to do before “gender affirmative” treatment was advertised 24 hours a day, 7 days a week. Only a few years ago, this would have been seen as just common sense caution. Adults-only transition was the norm.

There are other ramifications besides infertility resulting from this reckless rush for earlier and earlier surgeries and hormonal treatments. Here, Olson-Kennedy and other commenters analyze the impact of surgeries on sexual function—but disagree on how much should be discussed with the kids themselves about their future orgasm potential after their genitalia have been surgically rejiggered.

At least one “practitioner” seems not to want concerns about orgasm potential to be a “hindrance” to a child achieving their “authentic self”:

Bringing us into 2017, Jenn Burleton, head of Transactive Gender Center, assured the Facebook group on January 18 that orgasm is a discussion topic amongst “caregivers” in Transactive support groups. Good to know parents and other adults feel empowered to make decisions for these kids about their adult sexual function and fertility in their “support groups.”

(Just a thought: how many of these people publicly pontificating about the sexual function of children consider how they’d have felt as teens if adults had been scheming about their orgasm potential, and the impact thereon from a surgeon’s scalpel?)

In January 2017, nearly a year after Olson-Kennedy’s original post calling for the WPATH Standards of Care 8 to support earlier genital surgeries, many clinicians, activists, and parent leaders of trans youth groups remain keenly interested in lowering age of surgeries for youth. From the sounds of it, “many many” surgeons are eager to oblige.

Dan Karasic, MD, director of a gender clinic at UC San Francisco, moderator of the WPATH Facebook page, and a key player in WPATH and the co-chair of the recently formed USPATH, helpfully informs us that a discussion on under-18 surgeries will take place at the inaugural USPATH conference February 5 2017. “Advocacy” to pressure insurance companies to get onboard and pay for genital surgeries on minors is also an important part of the discussion.

This isn’t the first time we’ve seen Dr. Karasic advocating for lowering the age for surgeries. In this post, we discussed his public support for a mother obtaining double mastectomy for her 15-year-old and her attempts to get her insurance company to foot the bill for it.

Again: The people advocating for drastic and irreversible medical interventions on minors have enormous power over the future lives of children. The decisions they have taken with their careers and activism will impact a generation of youth for a lifetime. These adults, trans or not, were allowed to mature without medical interference in the era preceding this Age of the Trans Child.

Some of the people weighing in are trans adults, among them MTFs who have fathered children and had successful careers, who were not subjected to tampering and scheming about their most private and personal bodily functions as children. And as much as the trans activists may claim they’d have welcomed such interventions as children, the fact remains: Somehow they made it to adulthood, fertility and sexual function intact, without killing themselves.

Exactly what authority gives these people the right to advocate for and perform medical experiments on children, “trans” or not? This is a question a lot more people need to be asking.

Meanwhile, the USPATH conference session on surgery in minors is on Sunday, February 5 at 10:15 AM in Los Angeles.

Readers will undoubtedly recognize some of the names on this panel.

For more information about the irreversible sterilizing effects of puberty blockers followed by cross-sex hormones on prepubescent children, see below. Readers contributions are welcome and will be added to this list.

Sahar Sadjadi, The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?

It must be remembered that puberty suppression as the first step to medical transition, if followed by cross-sex hormones, which has been the case for almost all reported cases, leads to infertility due to the permanent immaturity of the gonads and the reproductive tract. The absence of the discussion of sterilization of children as a major ethical challenge in this bioethics article, and many other clinical debates on puberty suppression, is striking. For any other group of children, such an intervention would be discussed extensively with ethics review boards. (What grounds might justify the permanent elimination of the child’s reproductive ability? Should parents be able to make such a decision for the child? Which futures are opened by the treatment and which ones are foreclosed? How might benefits be weighed in relation to the loss of reproductive capacity?) The media would likely react with investigations and questions about the long-term consequences of treatment. These “queer” children’s bodily integrity and reproductive rights should not be any less pressing than other children’s. Needless to say, children are not legally capable of consent, and 9–10 year olds are not capable of understanding all the health consequences of the treatment. Parents are asked to make life decisions on issues as critical as fertility for young children. Can they make an informed decision and evaluate benefits vis a vis risks when confronted with such horrendous forecasts for their children?

Unique ethical and legal implications of fertility preservation research in the pediatric population

Norman Spack, MD, founder of first US pediatric gender clinic:

The biggest challenge is the issue of fertility. When young people halt their puberty before their bodies have developed, and then take cross-hormones for a few years, they’ll probably be infertile. You have to explain to the patients that if they go ahead, they may not be able to have children. When you’re talking to a 12-year-old, that’s a heavy-duty conversation. Does a kid that age really think about fertility? But if you don’t start treatment, they will always have trouble fitting in. And my patients always remind me that what’s most important to them is their identity.

Brill & Pepper, The Transgender Child, 2008, p. 216

“The choice to progress from GnRH inhibitors to estrogen without fully experiencing male puberty should be viewed as giving up one’s fertility, and the family and child should be counseled accordingly”. For girls, sterilization is the outcome too, because “eggs do not mature until the body goes through puberty”

Diane Ehrensaft, video clip from conference. Time stamp: 5:06

“Another thing that’s a show-stopper around [parents] giving consent is the fertility issue. That if the child goes directly from puberty blockers to cross- sex hormones they are pretty much forfeiting their fertility and won’t be able to have a genetically related child.”

Robert Garofolo, PBS.org:

“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.

GenderCare: London private clinic with a winning business model

Posted on January 20, 2017 by 4thwavenow

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by SunMum

The author is a UK academic and mother of a son who experienced sudden onset gender dysphoria. She has attended the Gendered Intelligence parents support group, and her son consulted Stuart Lorimer at GenderCare. She can be found on Twitter as SunMum@Mum3Sun

The business model of a private gender clinic in the UK looks a dead cert. To start with, you need demand, and the rising demand for gender reassignment services offers that in abundance. The NHS offers a gender reassignment pathway, but demand in recent years has outstripped the resources of a publicly funded health service. Waiting lists at the main adult provider, the Charing Cross Gender Identity Clinic, the UK’s ‘oldest and largest adult clinic’ founded in 1966, are currently about 12 months from the first referral. Referrals have ‘almost quadrupled in 10 years, from 498 in 2006-07 to 1,892 in 2015-16’ according to the Guardian in July 2016.

At the Tavistock and Portman, the only NHS service for children and adolescents with gender dysphoria, referrals have increased ‘about 50% a year since 2010-11.’ In the year leading up to this Guardian report, the rate of change in child referrals showed ‘an unexpected and unprecedented increase of 100%, up from 697 to 1,398 referrals’.

In the same 2016 Guardian article, Charing Cross GIC lead clinician James Barrett comments jocularly on this sudden increase in demand:

‘It obviously can’t continue like that forever because we’d be treating everyone in the country, but there isn’t any sign of that levelling off.’

Now this is a rather strange comment, given that only five years before, in 2011, Barrett stated that rates of gender dysphoria were stable and unchanging. Citing a 1996 study, he presented the condition as vanishingly rare: ‘It seems that the incidence of transsexualism is very roughly 1 in 60000 males and 1 in 100000 females, and it seems to have remained constant’. Given that ‘treatment is drastic and irreversible’, Barrett insisted that diagnosis must be entrusted to the experts of the gender identity clinic:

The least certain diagnosis is that made by the patient, made as it is without any training or objectivity. This uncertainty is not lessened by the patient’s frequently high degree of conviction. Neither does the support of others with gender dysphoria help, since conviction leads people to associate with the likeminded and to discount or fail to seek out disharmonious views. [ James Barrett, Advances in psychiatric treatment (2011), vol. 17, 381–388 doi: 10.1192/apt.bp.109.007484)

Pitching the service: Respect and Authority

GenderCare, headed by Stuart Lorimer, is a private London gender clinic mostly staffed by clinicians employed at Charing Cross GIC: endocrinologist Leighton Seal, psychologist Christina Richards and speech therapist Christella Antoni. These are professionals who have reputations at stake.

And while GenderCare does offer some Skype and email consultations, prospective patients or parents of gender confused young adults can be reassured that this is not an online clinic like that run by Helen Webberley, a Welsh GP whose Online Transgender Medical Clinic displays no more relevant qualifications than a one hour e-course in ‘Gender Variance’ designed by a transactivist organisation for GPs.

Twitter contains some negative reports of Webberley’s outfit: ‘A guy I know was rushed into hospital with liver failure because of Dr W’s incompetence, not having his bloods reviewed meant he was on too high a dosage of testosterone & literally nearly died.’ According to one young person, Webberley ‘has this weird online ‘grooming’ thing going on, contacting young people via social media’. Of course, Twitter testimonials do not constitute actual evidence and should be viewed with caution. Yet it’s clear to anyone who spends time investigating that young people are discerning as they sift through their choices and look for medical help they trust.

The GenderCare website by contrast is reassuringly respectable: these are ‘Specialists in Gender Care’, genuinely experts in their field. The site and FAQ frequently remind us that patients will be seen by a team of medical experts The FAQ emphasises hormonal treatment, with assurances that the letter needed for medical transition will be prepared as quickly as possible.

What would be the hurry? It appears that, since 2011 when Lorimer’s Charing Cross colleague James Barrett insisted on the ‘drastic and irreversible’ nature of medical transition and the caution that the ‘least certain diagnosis is that made by the patient’, there has been a sea change in the field. Now Barrett presents gender dysphoria as a condition with no parallel. It simply is what it is, and gender specialists are sui generis: neither psychiatrists, nor endocrinologists, but what it says on the can: ‘gender specialists’. Barrett compares gender dysphoria in a 2016 blog post for the BMJ, to ‘the Australasian Platypus’[full article behind paywall]:

The first specimens were dismissed as a joke of some sort.

But then more came, and alive and kicking at that. There followed a mighty taxonomological struggle. They were reptiles or perhaps some sort of bird, surely, as they were warm blooded, laid eggs and were venomous. On the other hand, the fur argued for mammals, but they didn’t have proper breasts, the defining feature of the mammals, and that business of being venomous is more of a reptile-like thing, is it not? And they do lay eggs…but warm blooded…perhaps a bird of some sort…?

In the end, it was all solved by everyone admitting that the Platypus was real, important, couldn’t be dismissed and didn’t fit any existing category very well. It got its own, special category where it has paddled, very happily, ever since, albeit joined by echidnas and some long-extinct fossilised forebears.

The comparison is witty and memorable, but leaves us no wiser. Lorimer also subscribes to what we might call the Platypus model of gender theory (‘a variety of clinical specialisms might lay reasonable claim to ownership of gender care but, like the platypus, it’s its own creature, distinct and different’. Although trained as a ‘Liaison psych’ he believes that ‘ultimately, it’s about pragmatism – who has the appropriate skill-set to do the work.’

For gender identity, there is no well-founded theoretical model, no objective test: we simply have to believe in the authority of the expert. Believe me because I say so. For the young people who visit GenderCare, diagnosis by a gender specialist offers confirmation and validation of their internal sense of self. YouTube videos about ‘my first visit’ to GenderCare form a genre of their own, revealing the overwhelming power of this validation. One young person reports

‘It were a really positive experience. He were very validating and he shouldn’t have been because I obviously know that someone validating your experience isn’t necessary. But hearing him saying the words saying he’s diagnosed me, he’s signing me off…It’s like all my Christmases come at once.’

There are many transition YouTubes made by young clients of Dr. Lorimer; they are moving videos, in which these young people freely admit they suffer with self harm and sometimes suicidality. A single visit to GenderCare can apparently provide a rapid remedy. The process is quick and simple: when blood tests are in and the letter comes through, a young woman who desires to transition FTM can start testosterone. One has already got ‘syringes through the post’, the ‘sharps bin’ and the needles:

‘I don’t know if you’ll be able to see this. Look at the fucking size of that needle. Look at it compared to the size of my finger. Well clearly I’m not needle-phobic. But fuck, it’s huge. I’d hit myself in the face with a brick if it meant starting on testosterone.’

Pushing at the boundaries

In taking on private work, Lorimer would need to protect his professional reputation and adhere to legal and medical regulations. This may at times present complications. In 2014, according to a post on ‘The Angels’ (a trans support forum), the UK’s Care Quality Commission (CQC) raised questions about the ‘grey area’ of his private practice, prompting Dr Lorimer to temporarily stop seeing clients.

Leaving aside the question of what may or may not have happened in 2014, the key regulatory boundaries with gender reassignment are to do with time (how quickly hormones are dispensed) and age (those under 18 are treated in a different way from adults). For much of 2016, the GenderCare website warned that hormones are not normally prescribed on a first visit. That is certainly not the belief expressed on Twitter today:

The burgeoning youth market

GenderCare’s FAQ tells us they primarily treat over-18s, although some exceptions are made. Lorimer confirms this on Twitter:

Earlier in this post, we saw that some young people on Twitter were freaked out by what one calls ‘this weird online grooming thing going on’ by Helen Webberley’s outfit. The respectable GenderCare would surely do no such thing. But Lorimer too has a social media presence through which he touts for business, a Twitter voice seemingly designed to speak to the young – especially trans men. Here we find him mythologizing the joys of testosterone:

Parents know that when young people want something, they want it Now! And for some young women the thing that is needed, and needed quickly, is testosterone, seen by dysphoric adolescent females as a panacea for all ills.

About ‘two thirds’ of his patients, Lorimer explains are ‘trans men’:

Like the proverbial high court judge, I need to make my way over to the Urban Dictionary . But Lorimer is the doc who talks to young people, who plays knowingly with the idea of ‘A girl’s body and the way she carries it.’ Looking at YouTube or at Twitter, you would think that Stuart Lorimer was an expert on adolescent gender dysphoria. But this apparently is not the case:

Lorimer may have ‘extremely limited experience of children/adolescents’. But it takes a very limited dip into the sea of adolescent angst freely available on Twitter and YouTube to realise that GenderCare clients are in the throes of the kinds of relationship and body issues that many adults remember. These are not strange young people, but people suffering from a horribly familiar set of feelings. Of course, we don’t know the age of all those who tweet of vlog about their GenderCare appointments. They might simply be youthful in spirit, but young they certainly appear to be. These don’t sound like people who are approaching ‘drastic and irreversible’ bodily alterations with maturity, discretion or objectivity:

Perhaps most troubling is that in 2016 Lorimer arrived on Tumblr, overwhelmingly a place for young people (very popular with ages 13-18), with a GenderCare Tumblr site. Lorimer seems anxious. Why? Is it because he knows he’s rather old to be on Tumblr?

Tumblr is full of accolades for GenderCare. And whilst one might think a need for hormones and surgery would be necessary only for those who strongly believe themselves to be the opposite sex, evidently even ‘nonbinaries’ are supported in their quest for medical intervention via GenderCare:

Lest readers think this nonbinary stuff is hyperbole, Dr Lorimer (aka The MXMaster) confirmed the Tumblrite’s observation on Twitter last August.

The market potential for ‘nonbinaries’ must be unlimited. Who amongst us fully conforms to gender stereotypes? And GenderCare isn’t the only UK gender clinic cashing in on the ‘enbie’ market:

Let’s see: Can you spot the difference between ‘non-binary’ and ‘binary’ mastectomy?

But returning to GenderCare, one of the more ironic aspects of all this is that Lorimer himself is certainly old enough and wise enough to see beyond the teenage rush for bodily alteration. A highly flattering image of Lorimer appears on the website of photographer James M. Barrett (not the gender clinician this time but a photographer who specialises in beautiful images of gay men). The photographer’s Facebook page comments sagely on the contemporary rush for bodily alteration:

‘In popular culture, there is an extraordinary urgency to take charge of our bodies and minds, and to “become the person that we were always meant to be”! It is as if we can rewrite our lives and give birth to new selves, simply through the power of positive self-belief, and some bloody good cosmetic work on our physical appearance! It is not just a practical idea that looking more attractive might increase our pulling power or lift our spirits. It is the fantasy that if we could just become achingly beautiful, then we will also be unbearably desirable, and our whole lives will be transformed from ordinary to unique. And of course, digital photography plays right into this fantasy, allowing us to perform virtual nick-and-tuck manipulations, and to airbrush a veneer of youthfulness onto our imagined selves. The images in this portrait series have also been heavily worked in post-production, but the effect is meant to suggest something very different: a harsh beauty that resonates with uncertainty, doubt, restlessness, world-weariness, perhaps mid-life crisis…but which also carries a tender intimacy, resilience, ruggedness, and a new-found robustness that comes from surviving a crisis.’

Wise words. And we know that Lorimer subscribes to this aesthetic. Not only has Barrett photographed him but under another image a ‘Stuart Lorimer’ comments: ‘Fantastic portrait!’. In his own photograph, Lorimer looks great: retouched, digitally improved, there is no necessity for cosmetic surgery, drugs, or scalpels.

For professional purposes, simpler photographic techniques suffice:

Now Lorimer knows, for certain, that Tumblr is for young people:

‘Tumblr, like lycra is probably not for anyone over 30 –yet here I am. Every fibre in my fortysomething being is screaming at me “GO! THIS IS FOR YOUNG PEOPLE!” but I’m resisting that because I think it may be useful for me to tout for lucrative business, as head of GenderCare, to have a presence here.’

Why? Maybe because young people use Tumblr to explore sub cultures of body hatred and body alteration. Lorimer is careful to add a disclaimer that he does not represent his ‘NHS employers or my GenderCare colleagues’.

But there is no escaping the fact that this is the official GenderCare Tumblr. There is no doubt that he is advertising transition services. In this location, Lorimer does not share his wise appreciation of the power of digital photographic enhancement to act out our fantasies. Instead he offers age-appropriate ‘links to things I find diverting that are not especially relevant (cute animals)’:

Don’t worry, young person about your first trip to get T. You will meet a cuddly gender doc wearing a pink suit.

After all, this is all a game, a joke. Fun. Isn’t it?

Well I for one don’t think it is. My son, you see, became seriously depressed in his second year at university and developed sudden onset gender dysphoria. No earlier signs, easily the most ‘boyish’ of my boys. But after a romantic rejection and drug experimentation he developed depersonalization, googled his symptoms, found they were a symptom of trans, stopped washing, seeing his friends, his handwriting changed, he made odd repetitive hand movements, he became angry and he stayed up all night. I thought he was having a breakdown. His GP thinks it is depression or maybe schizophrenia. But, urged on by a counsellor, I in my naivete paid out for an assessment at GenderCare. After all, the clinicians were the real thing, weren’t they? They all worked at Charing Cross GIC in the NHS. They couldn’t be just cynical or stupid, could they?

I was astounded when my son came back telling me that he would be starting hormones in a few weeks. I emailed GenderCare and asked whether I could supply some contextual information. Lorimer contacted my son to ask permission (since he was 22 at the time). Son said yes, so I sent off a timeline of events, including details that I thought might be relevant to a diagnosis, including a series of recent traumatic events. Lorimer duly wrote a report saying he was a bit worried and wanted a second opinion. The second opinion was with his colleague at Charing Cross GIC, James Barrett (not the photographer, who could only have beautified my beautiful son digitally acting out his fantasies). As Barrett had no access to context (this time son said No), he had an avuncular chat with son (cost £200) and advised on choosing a new name and the right to access female toilets. My son, who a family therapy team thought was ‘struggling with his decision to transition’, now repeatedly refers to the fact that he has been ‘diagnosed by two gender experts’. But in this matter, there is no diagnosis: doctors simply echo back to patients their own self-diagnosis. And the first doctor to offer him that external recognition was Stuart Lorimer.

GenderCare combines accessibility to the young through its active presence on social media, with a show of clinical expertise. The recent news that the Charing Cross GIC would be run within the Tavistock and Portman NHS trust led Lorimer to comment on ‘that potentially big plus. Possibilities for great cross-fertilisation between child and adult services.’ He wouldn’t notice the crassness of the metaphor, because what Lorimer is breeding is a business model; the fertility of confused young people is neither here nor there.